PATAH

PATAH TULANG
TULANG DAN
DAN
SENDI
SENDI

Dr. Ketut Martiana

DEPT.
DEPT. OF
OF ORTHOPAEDICS
ORTHOPAEDICS SURGERY
SURGERY
AIRLANGGA
AIRLANGGA UNIVERSITY/
UNIVERSITY/
DR.
DR. SOETOMO
SOETOMO HOSPITAL
HOSPITAL
SURABAYA
SURABAYA

DR. KETUT MARTIANA

05/19/24 1
 DEFINISI PATAH
TULANG
 Adalah hilangnya
kontinyuitas tulang
 Dapat diakibatkan
oleh trauma maupun
keadaan patologis

DR. KETUT MARTIANA

05/19/24 2
 Macam-macam fraktur

 Fraktur akibat trauma

yang adekwat
 Akibat kecelakaan lalu
lintas
 Kecelakaan kerja
 Jatuh dari ketinggian
 Fraktur patologis
 Trauma minimal pada
tulang yang sudah
patologis: tumor,infeksi,
osteoporosis 05/19/24 3
DR. KETUT MARTIANA
 Macam-macam fraktur
 Fraktur terbuka
 Fraktu yang disertai dengan luka,
dimana tulang pernah atau sedang
berhubungan dengan lingkungan luar
 Syarat: luka berjarak < 5 cm dari
patahan tulang
 Fraktur tertutup
 Fraktur yang tidak disertai luka

DR. KETUT MARTIANA

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 Macam bentuk fraktur
 Transverse / sederhana
 Oblique
 Spiral
 Akibat trauma yang
memuntir
 Comminutive
 fragmen lebih dari 2 buah
 Greenstick
 Khusus pada anak-anak

DR. KETUT MARTIANA

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 Penyembuhan Tulang
 Fase hematom
 Fase proliferasi sel
 Fase kalus
 Fase konsolidasi
 Fase remodelling

DR. KETUT MARTIANA

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 Prinsip Perawatan Fraktur

 ABC
 Reposisi
 Immobilisasi
 Fiksasi /stabilisasi
 Rehabilitasi

DR. KETUT MARTIANA

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 Jenis Reposisi

 Reposisi tertutup
(close reduction)
 Reposisi terbuka
(Open reduction)

DR. KETUT MARTIANA

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 Jenis Imobilisasi

 Cast imobilisation
 Traction
imobilisation
 Instrumentation
imobilisation

DR. KETUT MARTIANA

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 Macam Traksi

 Traksi kulit / skin traction

 Dari bahan plester
 Tulang di tarik melalui kulit
 Maksimum 2 minggu dan beban 5
kg
 Traksi tulang / skeletal traction
 K- wire atau steinmann pin
 Langsung menarik tulang
 Beban sampai 20 kg

DR. KETUT MARTIANA

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 JENIS INSTRUMENTASI

 INTERNAL
FIKSASI

 EKSTERNAL
FIKSASI

DR. KETUT MARTIANA

05/19/24 11
 DI NEGARA MAJU
In North America, and I suspect in most other technically
advanced countries, closed methods of fracture
management are in a marked decline. The ability to
produce anatomical alignment and maintain it by
internal fixation, particularly by interlocking nails, is
apparently making such methods passé. It has been our
observation during the past 5 years that orthopaedic
residents are incapable of applying casts with any
degree of dexterity, although they are very expert in
inserting a variety of nails. Similarly, the application of
traction is an arcane, antique procedure of historical
interest alone
Charles A. Rockwood, JR 1996

DR. KETUT MARTIANA

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 KOMPLIKASI FRAKTUR
lokal
 Nonunion and Malunion
 Infection
 Nerve Injury
 Vascular Injury
 Compartment Syndrome
 Refracture
 Muscle and Tendon
Entrapment and
Adherence

DR. KETUT MARTIANA

05/19/24 13
 KOMPLIKASI FRAKTUR
sistemik
 Shock
1.
1. Hematogenic
Hematogenic (oligemia)
(oligemia)
2.
2. Neurogenic
Neurogenic (caused
(caused primarily
primarily byby
nervous
nervous influences)
influences)
3.
3. Vasogenic
Vasogenic (initially
(initially decreased
decreased
vascular
vascular resistance
resistance and
and increased
increased
vascular
vascular capacity)
capacity)
4.
4. Cardiogenic
Cardiogenic (caused
(caused byby either
either
failure
failure of
of the
the heart
heart as
as aa pump
pump oror
diminished
diminished cardiac
cardiac output
output from
from
various
various causes)
causes)

DR. KETUT MARTIANA

05/19/24 14
TABLE 8-1
Classes of Acute Hemorrhage

Class I Class II Class III Class IV

Blood loss (mL) 750 1000-1250 1500-1800 2000-2500
Blood loss (units) 1-2 2-3 3-4 5
Blood loss* (%) 15 20-25 30-35 40-50
Pulse rater† (bpm) 72-84 >100 >120 >140
Blood pressure (mm Hg) 118/82 110/80 70-90/50-60 <50-60 systolic
Pulse pressure (mm Hg) 36 30 20-30 10-20
Capillary blanch test Normal Delayed Delayed Delayed
Respiratory rate 14-20 20-30 30-40 >35
Urine output (mL/h) 30-35 25-30 5-15 Negligible
Central nervous system—mental status Slightly anxious Mildly anxious Anxious and
confused Confused-lethargic
Fluid replacement Crystalloid Crystalloid Crystalloid + Blood Crystalloid +
Blood
*

Percentage of blood volume in a standard 70-kg man. † Assume normal of 72 bpm. Assume normal of
120 / 80 mm Hg. (Alexander, R.H., and Proctor, H.J.: Shock. In Committee on Trauma (eds): Advanced
Trauma life Support Manual—Program for Physicians, p. 86. Chicago, American College of Surgeons,
1993.)

DR. KETUT MARTIANA

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 KOMPLIKASI FRAKTUR
sistemik
Fat Embolism Syndrome/Acute
Respiratory Distress Syndrome
high-energy long-bone fracture
2 or 3 days after trauma
respiratory distress
pulmonary edema
temperature 39° to 40°C
Tachypnea

confusion, stupor, or coma

craniocerebral trauma ?

Perdarahan
Infeksi / Sepsis
DR. KETUT MARTIANA
05/19/24 16
 Prognosis
tergantung dari
 Umur
 Lokasi fraktur
 Terbuka/tertutup
 Macam imobilisasi
 Komplikasi
 rehabilitasi

DR. KETUT MARTIANA

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